Illinois Statutes

Public Act 102-0144;  215 ILCS 124/10

This amendment enhances network adequacy standards for timely and proximate access to treatment for MH/SUD conditions must satisfy specified minimum requirements. The revisions also clarify that that if there is no in-network facility or provider available for an insured to receive timely and proximate access to treatment MH/SUD conditions in accordance with the minimum network adequacy standards, the insurer shall provide necessary exceptions to its network to ensure admission and treatment with a provider or at a treatment facility in accordance with those network adequacy standards.

Enacted through SB 471; signed by the Governor on July 23, 2021.

Public Act 102-0579; 215 ILCS 5/370c.

The new law amends the Illinois insurance code to require commercial insurers, health insurance marketplace plans and Medicaid managed care organizations to:

• Medically Necessary Care. Cover medically necessary medically necessary treatment of mental health and substance use disorders (MH/SUD).
• Generally Accepted Standards of Care. Base any medical necessity determination or the utilization review criteria on current generally accepted standards for MH/SUD treatment.
• Nonprofit Review Criteria. Conduct utilization review of covered health care services and benefits for the diagnosis, prevention, and treatment of MH/SUD conditions in children, adolescents, and adults, an insurer shall exclusively apply the criteria and guidelines set forth in the most recent versions of the treatment criteria developed by the nonprofit professional association for the relevant clinical specialty.
• Utilization Review Parity. Not apply different, additional, conflicting, or more restrictive utilization review criteria than the criteria and guidelines set forth in the treatment criteria.
• No Dumping to Public Programs. Not limit benefits or coverage for medically necessary services on the basis that those services should be or could be covered by a public program.

The new law authorizes the Insurance Director may, after appropriate notice and opportunity for hearing, assess a civil penalty between $5,000 and $20,000 for each violation.

Enacted through HB 2595 signed by the Governor on August 25, 2021.

The law amends the ILCS by adding a new section 215 ILCS 5/370c.2 to provide that the Department of Insurance shall form a task force to review the plans and policies for individual and group short-term and long-term disability income insurance issued and offered to individuals and employers in this State to examine the use of such insurance for behavioral health conditions. The task force shall be comprised of experts in the disability income insurance industry, experts in the behavioral health conditions and treatment industry, members of the general public, and members of the General Assembly.  The task force shall submit findings and recommendations to the Governor and the General Assembly by December 31, 2020. Dissolves the task force on December 31, 2021.

Enacted through  SB 1449

Section 6 amends 5 ILCD 375/6.11 to require school district health plans to comply with the Federal Parity law. Additionally, the bill: Removes barriers to SUD medications by prohibiting prior authorization and step therapy for MAT medications and requires such medication to be placed on the lowest tier; Requires all medical necessity requirements to be made in accordance to ASAM criteria; Creates reporting requirements, including requiring: overseeing regulators to actively enforce provisions of the Federal Parity law and submit to the General Assembly and make public a report detailing all enforcement, oversight, correctional, and educational efforts and actions taken to ensure compliance with MHPAEA and state statutes, including completing and reporting on market conduct examinations and parity compliance audits and health plans to submit detailed parity compliance analyses completed using specified guidelines and processes

Public Act 100-1019 amends 305 ILCS 5/5-5.25 by allowing clinical psychologists, clinical social workers, advanced practice registered nurses, and mental health professionals and clinicians acting within their scope of practice to be reimbursed through Medicaid for service offers via telehealth. Additionally, any Medicaid certified eligible facility or provider organization that acts as the location of the patient at the time a telehealth service may be reimbursed through Medicaid.

Public Act 100-0184 established an Advisory Council on Early Identification and Treatment of Mental Health Conditions Act within the Department of Human Services. Specifically, the Advisory Council shall:
(1) Review and identify evidence-based best practice models and promising practices supported by peer-reviewed literature being implemented in this State and other states on regular screening and early identification of mental health and substance use conditions in children and young adults, including depression, bi-polar disorder, schizophrenia, and other similar conditions, beginning at the age endorsed by the American Academy of Pediatrics, through young adulthood, irrespective of coverage by public or private health insurance, resulting in early treatment;
(2) Identify evidence-based mental health prevention and promotion initiatives;
(3) Identify strategies to enable additional medical providers and community-based providers to implement evidence-based best practices on regular screening, and early identification and treatment of mental health conditions;
(4) Identify barriers to the success of early screening, and identification and treatment of mental health conditions across this State, including but not limited to, treatment access challenges, specific mental health workforce issues, regional challenges, training and knowledge-base needs of providers, provider infrastructure needs, reimbursement and payment issues, and public and private insurance coverage issues;
(5) Based on the findings, develop a set of recommendations and an action plan to address the barriers to early and regular screening and identification of mental health conditions in children, adolescents and young adults in this State;
(6) Complete and deliver the recommendations and action plan to the Governor and the General Assembly within one year of the first meeting of the Advisory Council; and
(7) Upon completion and delivery of the recommendations and action plan to the Governor and General Assembly, the Advisory Council shall be dissolved.
Public Act 100-0184 further discusses the compensation, meeting requirements and qualifications of the Advisory Council, and provides that the Department of Human Services shall provide administrative support.

405 ILCS 45/1 was deleted by HB 3502, which created Public Act 100-0184.
The Illinois Complied Statutes (ILCS) are a cumulative organization of Public Acts and most, but not all, Public Acts are incorporated in the ILCS. It does not appear that Public Act 100-0184 was incorporated into the ILCS and therefore, it is not referenced in 405 ILCS 45/1.

Adds subsection “g” to prohibit the following plans from imposing prior authorization requirements on specified ASAM level SUD treatment benefits: group health insurance policies, individual health benefit plans, qualified health plans that is offered through the health insurance marketplace, small employer group health plans and large employer group health plans. Furthermore, the law prohibits additional or unrelated diagnosis to be used as a barrier to deny related benefits to a beneficiary with a diagnosis of a SUD. Additionally, the law sets notification requirements, guidelines, and timelines for SUD providers to follow in order inform insurers or managed care organizations of the initiation of treatment and notice of discharge.
Beneficiaries are provided the right to external review and expedited external review pursuant to the Health Carrier External Review Act.

Enacted through  S.682

Public Act 100-0305 (Amends Insurance Code Sec. 370c. Mental and emotional disorders).

Public Act 100-0305 expanded the language of 215 ILCS 5/370c to require insurers that provide coverage for hospital and medical expenses under accident and health insurance or health care plan, for both individual and group policies, to provide coverage under the policy for treatment of serious mental illness and substance use disorders consistent with the parity requirements of Section 370c.1 of the Code. Public Act 100-0305 also expands the definition of “serious mental illness” to include eating disorders, including, but not limited to, anorexia nervosa, bulimia nervosa, pica, rumination disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder (OSFED), and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

215 ILCS 5/1 was deleted by and 215 ILCS 5/370c was amended by HB 1332, which created Public Act 100-0305.

Every insurer providing accident and health insurance or a qualified health plan offered through the Health Insurance Marketplace providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions shall ensure that the financial requirements and treatment limitations applicable to such mental, emotional, nervous, or substance use disorder or condition benefits are no more restrictive than those applied to substantially all hospital and medical benefits covered by the policy and that there are no separate cost-sharing or treatment limitation requirements that are applicable only with respect to mental, emotional, nervous, or substance use disorder or condition benefits.
215 Ill. Comp. Stat. Ann. 5/370c.1 continues on to discuss annual limits, compliance with the federal Mental Health Parity Act, and definitions applicable to the section.

Enacted through HB0001 (99th General Assembly)

Every insurer providing group or individual accident and health policies providing coverage for hospital or medical treatment or services for illness on an expense-incurred basis shall offer coverage for mental, emotional or nervous disorders or conditions, other than serious mental illnesses.
215 Ill. Comp. Stat. Ann. 5/370c continues on to define “serious mental illness” and other terms used in the section, time limits for treatment, and for medical necessity.

Enacted through HB 1530 (97th General Assembly)

This bill changed the state insurance law about autism so that children who were diagnosed with autism spectrum disorders will still be covered for autism treatment even if the diagnostic criteria for these disorders changes and they no longer meet the criteria.